title: Clinical characteristics of severe supracondylar humerus fractures in children.
abstract: BACKGROUND
  The safety of delayed surgical treatment of severe supracondylar elbow fractures in children remains debated. No large studies have evaluated complications of injury and surgery evaluating only type 3 fractures. Our aim was to review the results of our experience treating children with severe supracondylar elbow fractures at various time points after injury.
  
  
  METHODS
  All children treated operatively for supracondylar humerus fractures from 2004 to 2007 at a single pediatric trauma center were identified. A total of 1296 children had operative treatment, of which 872 had type 3 fractures. Clinical records were reviewed to identify time to surgery from presentation at our institution. Patients were grouped into 4 cohorts [<6 h (n=325), 6 to 12 h (n=224), 12 to 24 h (n=295), and >24 h (n=28)]. Emergency, operative, inpatient, and outpatient records were reviewed to determine morbidity at presentation as well as operative and postoperative complications.
  
  
  RESULTS
  There was no difference in sex, age, or energy mechanism between children in the various time groups. An absent pulse was found in 54 children (6%) at presentation, of which only 5 ultimately required a vascular intervention. Nerve injury occurred in 105 patients (12%). Use of a medial entry pin was not associated with ulnar nerve injury. Increased time from presentation to surgery was not associated with increased morbidity from the injury or treatment complications. In contrast, there was a trend to steady decrease in morbidity and complication rates with increased time to surgery.
  
  
  CONCLUSIONS
  This is the largest single-center study of severe supracondylar humerus fractures and describes rates of vascular compromise, nerve injury, infection, and other complications of these injuries. Most children with type 3 supracondylar humerus fractures can be treated safely in a delayed manner. Appropriate clinical judgment is imperative to optimize outcomes.
  
  
  METHODS
  Level III--retrospective comparative study.
authors.affiliation: *Department of Orthopaedic Surgery, Children's Hospital, University of Colorado, Aurora, CO †UT Southwestern, Children's Medical Center #Texas Scottish Rite Hospital, Dallas, TX ‡Mayo Clinic Rochester, MN §Emory University, Children's Healthcare of Atlanta, Atlanta, GA ∥St. Christopher Hospital for Children, Drexel University, Philadelphia, PA ¶Department of Orthopedics, Brown University, Providence, RI.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Garg
authors.forename: Amanda
authors.initials: A
authors.lastname: Weller
authors.forename: A Noelle
authors.initials: AN
authors.lastname: Larson
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Fletcher
authors.forename: Michael
authors.initials: M
authors.lastname: Kwon
authors.forename: Jonathan
authors.initials: J
authors.lastname: Schiller
authors.forename: Richard
authors.initials: R
authors.lastname: Browne
authors.forename: Lawson
authors.initials: L
authors.lastname: Copley
authors.forename: Christine
authors.initials: C
authors.lastname: Ho
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D057210:Delayed Diagnosis; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D015994:Incidence; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000293:injuries; D000092464:Elbow Injuries